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Cottom JM, Maker JM, Richardson P, Baker JS. Endoscopic Debridement for Treatment of Chronic Plantar Fasciitis: An Innovative Technique and Prospective Study of 46 Consecutive Patients. J Foot Ankle Surg 2016; 55:748-52. [PMID: 27066869 DOI: 10.1053/j.jfas.2016.02.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Indexed: 02/03/2023]
Abstract
Plantar fasciitis is one the most common pathologies treated by foot and ankle surgeons. When nonoperative therapy fails, surgical intervention might be warranted. Various surgical procedures are available for the treatment of recalcitrant plantar fasciitis. The most common surgical management typically consists of open versus endoscopic plantar fascia release. Comorbidities associated with the release of the plantar fascia have been documented, including lateral column overload and metatarsalgia. We present an innovative technique for this painful condition that is minimally invasive, allows visualization of the plantar fascia, and maintains the integrity of the fascia. Our hypothesis was that the use of endoscopic debridement of the plantar fascia with or without heel spur resection would provide a minimally invasive technique with acceptable patient outcomes.
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Affiliation(s)
- James M Cottom
- Fellowship Director and Attending Physician, Florida Orthopedic Foot and Ankle Center, Sarasota, FL.
| | - Jared M Maker
- Fellow, Foot and Ankle Surgical Fellowship, Florida Orthopedic Foot and Ankle Center, Sarasota, FL
| | - Phillip Richardson
- Fellow, Foot and Ankle Surgical Fellowship, Florida Orthopedic Foot and Ankle Center, Sarasota, FL
| | - Joseph S Baker
- Fellow, Foot and Ankle Surgical Fellowship, Florida Orthopedic Foot and Ankle Center, Sarasota, FL
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Lucas DE, Ekroth SR, Hyer CF. Intermediate-term results of partial plantar fascia release with microtenotomy using bipolar radiofrequency microtenotomy. J Foot Ankle Surg 2015; 54:179-82. [PMID: 25617155 DOI: 10.1053/j.jfas.2014.12.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Indexed: 02/03/2023]
Abstract
Plantar fasciitis is a common condition, with most patients treated successfully with nonoperative management. Recalcitrant disease has been managed with surgical procedures that vary in design and associated morbidity. The present study sought to determine the intermediate-term results of percutaneous bipolar radiofrequency microtenotomy in recalcitrant plantar fasciitis. The patient medical records were reviewed, and data were gathered for all the patients who met the inclusion criteria. The foot function index and visual analog scale (VAS) pain scale questionnaires were mailed to the 111 patients. Of the 111 patients, 61 (55.0%) returned their questionnaires and were ultimately included in the present analysis. Of the 61 patients, 44 (72.1%) were female and 17 were (27.9%) male, with an average reported follow-up of 33.3 ± 8.6 (range 16.1 to 46.6) months. The median postoperative VAS score was 0.0 (range 0.0 to 10.0), and the median foot function index score was 3.1 (range 0.0 to 97.1). The patients were subdivided into success and failure groups according to their satisfaction. Of the 61 patients, 51 (83.6%) were satisfied and would recommend the procedure to a friend. The median VAS score in the success group was 0.0 (range 0.0 to 5.0), and the median VAS score in the failure group was 6.0 (range 0.0 to 10.0), a significant difference (p < .001). A significant difference was also seen in the foot function index score between the success (median 2.4, range 0.0 to 25.7) and failure (median 37.4, range 0.0 to 97.1) groups (p < .001). Bipolar radiofrequency microtenotomy appears to be a safe procedure that can provide outcomes equivalent to those with open surgery, with less morbidity, for recalcitrant plantar fasciitis.
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Affiliation(s)
- Douglas E Lucas
- Fellow, Orthopedic Foot and Ankle Department, Stanford University School of Medicine, Stanford, CA
| | - Scott R Ekroth
- Attending Physician, Physician's Clinic of Iowa, Cedar Rapids, IA
| | - Christopher F Hyer
- Fellowship Director, Advanced Foot and Ankle Surgical Fellowship, Orthopedic Foot and Ankle Center, Westerville, OH.
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Gunes T, Bilgic E, Erdem M, Bostan B, Koseoglu RD, Sahin SA, Sen C. Effect of radiofrequency microtenotomy on degeneration of tendons: an experimental study on rabbits. Foot Ankle Surg 2014; 20:61-6. [PMID: 24480503 DOI: 10.1016/j.fas.2013.11.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2013] [Revised: 10/09/2013] [Accepted: 11/04/2013] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Radiofrequency microtenotomy is used to enhance healing by increasing vascularity in the degenerated tendon. In the present study, the effect of radiofrequency microtenotomy (Rf-mt) treatment on tendon degeneration was investigated. MATERIALS AND METHODS A total of 32 New Zealand rabbits were enrolled in the current study. Experimental degeneration was performed by injecting prostaglandin E1 (PGE1) into the bilateral Achilles tendons of rabbits. After excluding 4 rabbits with an infection on the injection site, 4 other rabbits were sacrificed to define the histopathologic changes in the tendons. The remaining 24 rabbits were divided into 2 groups: the control group and the Rf-mt group. In the control group, the Rf-mt device was only applied to the Achilles tendon without running the device. In the Rf-mt group, the Rf-mt device was applied bilaterally at the fourth energy level for 500ms to an area within 2cm proximal to the insertion site at 0.5cm intervals in order to form a grid. Six rabbits from each group were sacrificed at 6 and 12 weeks. The Achilles tendons were evaluated histopathologically by a modified Movin scale and by immunohistopathologic staining for vascular endothelial growth factor and type 4 collagen. RESULTS After the PGE1 injection, findings similar to chronic degenerative tendinopathy were observed. The Rf-mt group showed significant improvement in vascularity in the histopathological and immunohistochemical examination (P<0.05). However, there was no significant difference in healing between the control and Rf-mt groups (P>0.05). CONCLUSIONS Rf-mt treatment increases vascularity in degenerated tendons but does not create difference to facilitate the healing process comparing control group.
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Affiliation(s)
- Taner Gunes
- Gaziosmanpasa University School of Medicine, Department of Orthopaedics and Traumatology, Tokat, Turkey.
| | - Erkal Bilgic
- Gaziosmanpasa University School of Medicine, Department of Orthopaedics and Traumatology, Tokat, Turkey
| | - Mehmet Erdem
- Sakarya University School of Medicine, Department of Orthopaedics and Traumatology, Sakarya, Turkey
| | - Bora Bostan
- Gaziosmanpasa University School of Medicine, Department of Orthopaedics and Traumatology, Tokat, Turkey
| | - Resit Dogan Koseoglu
- Gaziosmanpasa University School of Medicine, Department of Pathology, Tokat, Turkey
| | - Seyyid Ahmet Sahin
- Erbaa State Hospital, Clinic of Orthopaedics and Traumatology, Erbaa, Tokat, Turkey
| | - Cengiz Sen
- Istanbul University, Istanbul Medical School, Department of Orthopaedics and Traumatology, Istanbul, Turkey
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Sorensen MD, Hyer CF, Philbin TM. Percutaneous bipolar radiofrequency microdebridement for recalcitrant proximal plantar fasciosis. J Foot Ankle Surg 2011; 50:165-70. [PMID: 21354000 DOI: 10.1053/j.jfas.2010.11.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2009] [Indexed: 02/03/2023]
Abstract
Success rates for traditional methods of surgical intervention for chronic plantar fasciosis are low, and associated with high rates of complications and long recovery times. The purpose of this prospective case series was to assess the effectiveness of percutaneous bipolar radiofrequency microfasciotomy for the treatment of recalcitrant proximal plantar fasciosis in 21 patients. The mean preoperative American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot score was 22.10 ± 12.96 (out of a possible 68 points) and the mean postoperative AOFAS hindfoot score was 59.57 ± 13.23 points, and this difference was statistically significant (P < .0001). A total of 7 (33.33%) patients experienced satisfactory pain relief within 1 to 4 weeks and 10 (47.62%) did so within 1 to 4 months, whereas 2 (9.52%) patients required longer than 4 months, and 2 (9.52%) others never attained satisfactory relief of symptoms. Fourteen (66.67%) patients subjectively rated their outcome as excellent, 4 (19.05%) as good, 1 (4.76%) as fair, and 2 (9.52%) as poor. One (4.76%) patient experienced iatrogenic flexor hallucis longus tendonitis. The results of this clinical investigation indicate that bipolar radiofrequency microdebridement plantar fasciotomy safely alleviates recalcitrant heel pain. The technique is minimally invasive and simple to perform, and it spares the overall integrity of the plantar fascia without being associated with undue complications.
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Deol P, Philbin T. Bipolar Radiofrequency Microtenotomy for Chronic Achilles Tendinosis. ACTA ACUST UNITED AC 2008. [DOI: 10.1053/j.oto.2009.02.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Lin JL, Carreira D, Ponnappan R, Volz B, Cole BJ. Use of bipolar radiofrequency energy in delayed repair of acute supraspinatus tears in rats. J Shoulder Elbow Surg 2007; 16:640-8. [PMID: 17583540 DOI: 10.1016/j.jse.2006.11.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2006] [Revised: 11/28/2006] [Accepted: 11/28/2006] [Indexed: 02/01/2023]
Abstract
The purpose of this study is to determine if bipolar radiofrequency energy (bRFE) can enhance delayed surgical repair of acute supraspinatus tendon tears. Bilateral supraspinatus tendon tears were created in 42 Sprague-Dawley rats and repaired at 6 weeks either with or without bRFE augmentation. There were 8 control (sham) rats. Treatment rats were euthanized at 4, 8, and 12 weeks after repair. All specimens underwent biomechanical and histologic evaluation. Compared with standard repair, bRFE-treated repairs showed a greater average maximum stress (8.475 N/m2 versus 3.95 N/m2) at 12 weeks, which was not significant (P < .11). The mode of failure was by humeral fracture in 57.14% > with bRFE versus 14.29% without bRFE. Histologically, both standard and bRFE-treated repairs were indistinguishable from controls at 12 weeks. The use of bRFE showed no definitive effect on delayed repair of acute rat rotator cuff tears.
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Affiliation(s)
- Johnny L Lin
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
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Yi GH, George I, He KL, Lee MJ, Cahalan P, Zhang G, Gu A, Klotz S, Burkhoff D, Wang J. Direct left ventricle-to-coronary artery stent restores perfusion to chronic ischemic swine myocardium. Heart Surg Forum 2006; 9:E744-9. [PMID: 16809127 DOI: 10.1532/hsf98.20061021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Direct left ventricle (LV)-to-coronary artery shunts (VSTENT) have been proposed as an alternative means of myocardial revascularization. The goal of this study was to examine quantitative changes in myocardial perfusion and possible mechanisms of revascularization with an LV-to-coronary shunt. METHODS Ameroid occluders were implanted on the proximal left anterior descending coronary artery (LAD) of 6 pigs to create chronic ischemia. Four weeks later, a VSTENT was placed to directly connect the distal LAD with the LV chamber. Animals survived for an additional 3 weeks and received periodic bromodeoxyuridine (BrdU) injections to identify dividing cells to identify and quantify angiogenesis. Regional myocardial perfusion (RMP) was measured with color microspheres under adenosine vasodilatory stress before and 3 weeks after VSTENT implantation. Vascularity was assessed histologically by an overall vascularity index and a growth index reflecting the density of BrdU-positive vascular cells. RESULTS Three weeks after VSTENT placement, RMP improved from 38.4% +/- 19.6% of non-ischemic flow to 86.8% +/- 13.7% in treated animals (P < .05). This benefit was accompanied by histological evidence of increased vascularity and vascular proliferation. Four of 5 animals had patent and functional devices at the end of the study. CONCLUSION Chronic VSTENT placement improves RMP and may promote arterial remodeling in chronically ischemic porcine myocardium.
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Affiliation(s)
- Geng-Hua Yi
- Department of Surgery, Division of Cardiothoracic Surgery, Columbia University College of Physicians and Surgeons, New York, New York, USA
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The Use of Bipolar Radiofrequency Microtenotomy in the Treatment of Chronic Tendinosis of the Foot and Ankle. TECHNIQUES IN FOOT AND ANKLE SURGERY 2006. [DOI: 10.1097/00132587-200606000-00008] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Tasto JP, Cummings J, Medlock V, Harwood F, Hardesty R, Amiel D. The tendon treatment center: new horizons in the treatment of tendinosis. Arthroscopy 2003; 19 Suppl 1:213-23. [PMID: 14673441 DOI: 10.1016/j.arthro.2003.10.004] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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Kantor B, Möhlenkamp S. Imaging of myocardial microvasculature using fast computed tomography and three-dimensional microscopic computed tomography. Cardiol Clin 2003; 21:587-605, ix. [PMID: 14719570 DOI: 10.1016/s0733-8651(03)00110-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
In the past, much attention in imaging research was focused on the macroscopic morphology and patency of arteries. Only recently, research and clinical interest have shifted to the microcirculation and its impact on the long-term prognosis in patients with vascular diseases. This focus and newly developed therapeutic strategies require high-resolution imaging modalities, which do not focus exclusively on the macroscopic aspects of the arterial tree. Provided here is a comprehensive perspective of using computed tomography technology to image and quantify the function and morphology of myocardial and vascular adventitial microvessels in normal and disease states.
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Affiliation(s)
- Birgit Kantor
- Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic and Foundation, 200 First Street SW, Rochester, MN 55905, USA.
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Szatkowski A, Ndubuka-Irobunda C, Oesterle SN, Burkhoff D. Transmyocardial laser revascularization: a review of basic and clinical aspects. Am J Cardiovasc Drugs 2002; 2:255-66. [PMID: 14727971 DOI: 10.2165/00129784-200202040-00005] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Transmyocardial laser revascularization (TMR or TMLR) is a surgical therapy developed to treat patients with debilitating, medically refractory angina pectoris due to epicardial coronary artery disease that is not amenable to treatment using the traditional methods of percutaneous coronary intervention (PCI) or coronary artery bypass graft surgery (CABG). This technique can also be applied percutaneously [percutaneous myocardial revascularization (PMR) or direct myocardial revascularization (DMR)]. The original hypotheses which motivated development of TMR were that: (i) oxygenated blood could flow directly from the left ventricle and perfuse the myocardium; and (ii) such artificially created channels would remain patent. However, experimental data have refuted both hypotheses. In the face of early reports of marked clinical benefits in terms of relief of anginal symptoms, alternate hypotheses to explain the mechanism have been pursued, including TMR-associated neoangiogenesis and cardiac denervation. Clinically, numerous reports of reduction in frequency and severity of anginal symptoms, improved exercise tolerance and improved quality of life have appeared from nonblind registry-type studies as well as nonblind randomized clinical trials of TMR or PMR versus continued medical therapy. TMR was not associated with a significant improvement in survival compared with medical therapy alone in randomized trials. For example, the prospective, randomized Angina Treatments-Lasers and Normal Therapies in Comparison (ATLANTIC) trial found a 1-year mortality of 5% in 92 TMR-treated patients and 10% in 90 patients treated with medication only. No proof of improved myocardial blood flow in hearts of treated patients is currently available. The first randomized study of PMR was the Potential Angina Class Improvement From Intramyocardial Channels (PACIFIC) trial which found significantly greater improvements in anginal symptoms and exercise tolerance with PMR plus medical therapy, compared with medical therapy alone. The preliminary results of two double-blind studies with PMR/DMR have been presented but have not yet been published in full. Whereas PMR-treated patients did significantly better than sham-treated control groups after 6 months in the Blinded Evaluation of Laser Intervention Electively For angina pectoris (BELIEF) trial, there was no difference after 1 year between DMR-treated patients and those treated with medication only in the DMR In Regeneration of Endomyocardial Channels Trial (DIRECT). Different devices used for revascularization in these two trials may explain the disparity in the results, and therefore the efficacy and tolerability of each device should be judged upon data collected with that particular device.
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Affiliation(s)
- Arie Szatkowski
- Department of Medicine, Division of Circulatory Physiology, Columbia University, New York, New York 10032, USA
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Díaz De Tuesta I, Martínez R. [Coronary artery bypass graft combined with transmyocardial laser revascularization. Survival and functional class at one-year follow-up]. Rev Esp Cardiol 2001; 54:1295-304. [PMID: 11707240 DOI: 10.1016/s0300-8932(01)76500-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION AND OBJECTIVES The use of Transmyocardial Laser Revascularization (TMLR) as a strategy to treat unstable angina has been reported in many studies. We analyze its safety and effectiveness in combined procedures (CABG + TMLR). METHODS A non-randomized, retrospective cohort study was performed from May 4, 1999 to May 25, 2000 in 21 TMLR patients (18 combined CABG + TMLR) and 118 CABG only procedures. Mortality and NYHA analyses were determined by telephone at follow-up. RESULTS Three hospital deaths were observed: one isolated TMLR patient, one valvular + CABG + TMLR patient, and one CABG + TMLR patient. A significantly higher incidence of preoperative angina was found in the group of patients with TMLR + CABG, than in the group with only CABG (83 vs 25%; p < 0.001). There were no differences in age, gender, ejection fraction, Parsonnet and EuroSCORE risk estimation, or mortality (5.1% isolated CABG, 5.6% combined). No episode of angina was detected during follow-up in the CABG + TMLR group: 88% patients were NYHA I, and 21% NYHA II. CONCLUSION Incomplete coronary revascularization may be complemented with TMLR in the areas in which CABG is not possible without increased mortality. This technique may avoid postoperative unstable angina due to residual ischemic areas.
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Affiliation(s)
- I Díaz De Tuesta
- Hospital Universitario de Canarias, 38190 La L aguna, SC Tenerife.
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ADVANCES IN THE SURGICAL TREATMENT OF CORONARY ARTERY DISEASE. Nurs Clin North Am 2000. [DOI: 10.1016/s0029-6465(22)02646-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Patel NH, Moresco KP, McLennan G, Dreesen RG. Percutaneous transmyocardial intracardiac retroperfusion shunts: technical feasibility in a canine model. J Vasc Interv Radiol 2000; 11:382-90. [PMID: 10735436 DOI: 10.1016/s1051-0443(07)61434-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
PURPOSE To test the technical feasibility of creating a left ventricle to coronary sinus shunt using endovascular techniques. MATERIALS AND METHODS By means of a right jugular vein approach, a needle puncture was made from the coronary sinus to the left ventricle in 10 dogs. The tracts were balloon dilated and lined with 6-mm Wallstents. Shunt patencies, immediate and 4-hours later, were fluoroscopically assessed by contrast material injection into the left ventricle. Blood pressure, pulse, oxygen saturation, and cardiac rhythm were monitored. The dogs were then euthanized. Thoracic cavities and hearts were dissected and inspected. RESULTS Technical success and immediate shunt patency were 100%. No cardiac dysrhythmias, electrocardiographic changes, or reduction in voltage potential were seen. Eight (80%) of the shunts were patent at 4 hours, one (10%) had thrombosed, and one dog died. Nine (90%) dogs had no pericardial hematoma and one (10%) had minimal pericardial blood from needle passes into the pericardial sac. The coronary sinuses were intact and no injuries to the valve leaflets or chordae tendineae were seen. The puncture sites were from the coronary sinus, 1-2 mm (mean, 1.3) from its auricular orifice, into the left ventricle, just below the inferior margin of the posterior leaflet of the mitral valve. One dog died at 3 hours with no preceding electrocardiographic evidence of impending demise. Autopsy showed no pericardial hematoma and the heart findings were no different from the other nine dogs. CONCLUSIONS Creation of a left ventricle to coronary sinus shunt with use of endovascular techniques is technically feasible. Study of a transmyocardial intracardiac coronary retroperfusion shunt to deliver oxygenated blood to the ischemic myocardium is warranted.
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Affiliation(s)
- N H Patel
- Department of Radiology, Indiana University Medical Center, Indiana University School of Medicine, Indianapolis 46202, USA
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Abstract
Despite the proven effectiveness of coronary bypass surgery and percutaneous angioplasty techniques, an increasing number of patients are presenting with severe, medically intractable angina who are not candidates for either procedure. Two alternative strategies, transmyocardial laser revascularization and exogeneous administration of angiogenic growth factors (therapeutic angiogenesis) are currently being evaluated in such patients. This review focuses on the current status of these two procedures, emphasizing their similarities and differences in order to provide insight into what role each may ultimately play in the management of patients with otherwise unrevascularizable myocardial ischemia.
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Affiliation(s)
- J F Symes
- St. Elizabeth's Medical Center, 11 Nevins Street, Boston, MA 02135, USA
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